Enteral Diet Research Articles

Early supplemental parenteral nutrition is associated with reduced mortality in critically ill surgical patients with high nutritional risk

Adequate nutritional provision is important for critically ill patients to improve clinical outcomes. Starting enteral nutrition (EN) as early as possible is recommended and preferred to parenteral nutrition (PN). However, patients who undergo emergency abdominal operations may have alterations in their intra-abdominal environment and gastrointestinal motility leading to limitation in starting an enteral diet. Therefore, our study was designed to evaluate the benefit of early supplemental PN to achieve adequate calorie and protein supply in critically ill patients undergoing surgery who are not eligible for early EN. We reviewed the medical records of 317 patients who underwent emergency abdominal surgery for complicated intra-abdominal infection (cIAI) between January 2013 and December 2018. The nutritional data of the patients were collected for 7 days in maximum, starting on the day of intensive care unit (ICU) admission. The patients were divided by low or high malnutrition risk using the modified Nutrition Risk in Critically ill (mNUTRIC) score and body mass index. The low- and high-risk groups were subdivided into the following two categories: those who received PN within 48h ("early") and those who did not ("usual"). Data regarding the baseline characteristics, initial severity of illness, morbidity, and mortality rates were also obtained. The average calorie and protein supply per day were calculated in these groups. Patients in all groups showed no significant differences in baseline characteristics, initial status, and infectious complications. In terms of outcomes, patients with low malnutrition risk had no significant difference in mortality. However, among patients with high malnutrition risk, the "Early" group had lower rates of 30-day mortality (7.6% vs. 26.7%, p=0.006) and in-hospital mortality (13.6% vs. 28.9%, p=0.048) than those of the "Usual" group. Kaplan-Meier survival curves for 30-day mortality in these groups also showed a statistically significant difference (p=0.001). The caloric adequacy of the "Early" group and the "Usual" group were 0.88±0.34 and 0.6±0.29, respectively. Amounts of protein received were 0.94±0.39g/kg in the "Early" group and 0.47±0.34g/kg in the "Usual" group, respectively. There was no significant difference in infectious complications between both groups. Mortality in patients with high malnutrition risk who received early PN supply within 48h after emergency surgery for cIAI was lower than those who did not receive PN earlier. PN may be necessary to fulfill the caloric and protein requirements for critically ill patients who cannot achieve their nutritional requirements to the fullest with EN alone.

497 Delayed Gastropleural Fistula: A Rare Cause of a Persistent Pleural Effusion After Blunt Force Trauma

Abstract Background A gastropleural fistula (GPF) is a rare pathological connection between the stomach and pleural cavity. GPFs have been reported following traumatic diaphragmatic ruptures, perforated hiatal hernias and gastric fundal ulcers, and more recently, after bariatric surgery. Diagnosis and treatment are frequently delayed due to the lack of specific clinical, laboratory and radiological findings. Method We describe a case of a 53-year-old gentleman who presented to our institution with acute respiratory distress and clinical findings of a pleural effusion. Uniquely he was discharged a week prior following an admission for a traumatic fall down a flight of stairs that resulted in a Grade-IV splenic injury, requiring an emergency splenectomy. A CT-proven massive haemothorax resulted in haemodynamic instability requiring resuscitation and chest drain insertion in the intensive care unit. On commencement of enteral diet, purulent exudate with evidence of food particulates was seen in his chest drain. Results Further diagnostic evaluation of drainage contents demonstrated gut flora and a subsequent positive dye test suggested an aero-digestive connection. Repeat CT revealed a fistula between the fundus of the stomach and the left pleural cavity through a ruptured diaphragm. He underwent an open sleeve gastrectomy and primary repair of the diaphragm. Conclusions This is the first case in literature reporting a ‘gastropleural fistula’ presenting in such a fashion. Thorough assessment and decisive action led to a satisfactory outcome. Although rare, a persistent effusion with a history of blunt abdominal and thoracic trauma may herald a GPF, which, if not diagnosed promptly, may result in significant morbidity.

Fish oil-based lipid emulsion alleviates parenteral nutrition-associated liver diseases and intestinal injury in piglets.

Thisstudy aimed to investigate the impact of fish oil-based lipid emulsion (FO) on enterohepatic injuries and intestinal microbiota in piglets of parenteral nutrition (PN). Newborn piglets were divided into three groups, including enteral diet (the controls), PN with 100% FO and PN with medium-chain triglyceride/long-chain triglyceride-based lipid emulsion (MCT/LCT) for 14 days. Serum biochemical indicators, hepatic and intestinal histology, and expression of genes associated with inflammation, oxidative stress, and lipid metabolism were measured. The bile acid (BA) profiles in serum and the taxonomic composition of the gut microbiome in different intestinal segments were analyzed. Compared with MCT/LCT-piglets, FO reduced inflammation, promoted fatty acid oxidation, and decreased oxidative stress in the liver. In the intestine, FO decreased intestinal inflammation and intestinal permeability, leading to reduced lipopolysaccharide entry into the blood circulation relative to MCT/LCT-piglets. PN groups have dominant contents of Proteobacteria and Bacteroides, whereas the control group have Firmicutes at the phylum level. FO altered the taxonomic compositions of the gut microbiome in different segments, increased the relative abundance of Bacteroidaceae in ileum, and Rikenellaceae and Ruminococcaceae in the colon. FO treatment shifted BA composition ratio in serum and had a lower ratio of secondary BAs to primary BAs. FO alleviates PNLAD and intestinal injury by regulating the homeostasis of BAs' enterohepatic circulation and altering microbiota composition in different intestinal segments.

Homogenised and pasteurised human milk: lipid profile and effect as a supplement in the enteral diet of Wistar rats.

The retention of human milk (HM) fat in nasogastric probes of infusion pumps can be observed during the feed of infants unable to suck at the mother's breast. The lack of homogenisation of HM could contribute to the fat holding. Therefore, the present study evaluated (i) the influence of homogenisation on milk fat retaining in infant feeding probes and (ii) the in vivo effect of the homogenisation on lipid absorption by Wistar rats. The animals were fed with HM treated following two processing conditions, that is, pasteurised and homogenised-pasteurised. The animals were randomly subdivided into four experimental groups: water-fed (control), pasteurised milk, homogenised-pasteurised milk and pasteurised-skimmed milk. The results of food consumption, mass body gain, corporate metrics and plasma blood levels of total cholesterol did not show any difference (P < 0·05) among the three types of HM used in the experiments. The liver, intestine and intra-abdominal adipose tissue of the four groups of animals presented normal and healthy histology. The composition of fatty acids in the brain tissue of animals fed with homogenised HM increased when compared with the groups fed with non-homogenised HM. These values were 11·08 % higher for arachidonic acids, 6·59 % for DAH and 47·92 % for nervous acids. The ingestion of homogenised HM promoted higher absorption of milk nutrients. Therefore, the addition of the homogenisation stage in HM processing could be an alternative to reduce fat retention in probes and to improve the lipids' absorption in the body.

Laparoscopic treatment of pyloric atresia in a newborn

Introduction. Pyloric atresia is one of the rarest surgical diseases in newborns. Laparotomy is the most common modality for correcting this abnormality. In modern scientific literature, there is only one report on the endosurgical treatment of pyloric atresia. The case of laparoscopic correction of gastric outlet atresia presented in this study is one more reference to the successful care of this condition.Material and methods. The presented clinical case is a newborn boy in whom a prenatal ultrasound examination at the 31st week of gestation revealed polyhydramnios and an enlarged stomach. The baby’s birth weight was 2660 grams. In the first hours of life, the child showed symptoms of high intestinal obstruction in the form of gastric content vomiting. Postnatal ultrasound and X-ray examination confirmed the diagnosis of pyloric atresia. During laparoscopy, performed on the 2nd day of life, the morphological type of anomaly was examined, and the type I atresia of membranous form was established. A laparoscopic membranectomy with Heineke–Mikulicz pyloroplasty was performed. In the final part of this research, early and late outcomes of the performed surgical treatment were analyzed.Results. The surgery lasted for 70 min. Postoperative period was uneventful. Enteral nutrition started on day 3 after the surgery. A complete enteral diet was possible on day 7. The newborn patient was discharged from the hospital on the 9th postoperative day. Histological examination confirmed the pyloric atresia of membranous type. During 12-month follow-up, no complications associated with the surgical procedure were seen.Conclusion. The described case of laparoscopic treatment of type I pyloric atresia in a newborn expands laparoscopy application in pediatric practice.

Evaluation of the ecoefficiency of greenhouse gases generation in the provision of complementary meals in a public hospital

The present study aimed to assess Ecoefficiency (EE) related to the emission of Greenhouse Gases (GHG) from the transport of the inputs used to provide complementary meals at a large university hospital in Brazil. For EE calculations, the annual energy supply in kilocalories of the inputs used and the estimated GHG emissions were considered, considering the distance in kilometers between the place of origin of each product and the destination city in southern Brazil. 31 products were used and selected for complementary meals distributed in the groups of: dairy products, cookies, drinks, supplements, and enteral diets for adults and pediatrics. The results showed that EE was directly related to the origin of the products, especially in enteral diets. The application of the Spearman correlation coefficient showed a strong negative correlation of -0.8119 [CI (95%) -0.9023; -0.6531] between the variables distance in kilometers and eco-efficiency and also when comparing GHG emissions with kilocalories. The health sector must play its role in relation to environmental impacts also in the assessment of GHG emissions in the context of nutritional therapy.

Enteral resorbable diet versus standard diet in primary sphincter reconstruction: a prospective randomised trial

AimBowel movements after reconstructive anorectal surgery may negatively affect surgical outcome. This study was aimed to assess any differences between a standard diet (SD) and the enteral resorbable diet (ED) in terms of operative outcomes and patient tolerance after fistulectomy with primary sphincter reconstruction.MethodAdult patients undergoing elective fistulectomy with primary sphincter reconstruction for anorectal and rectovaginal fistulas were eligible for inclusion. Patients were intraoperatively randomised to receive either the ED and peristalsis-inhibiting medication (ED) or a SD. The primary endpoint was the healing rate. Secondary endpoints included continence scores, complications and quality of life. Sample size calculation resulted in the analysis of 60 patients to detect a difference in fistula recurrence of 30% with 70% power and a 5% significance level.ResultsSixty-six patients (24 women) were prospectively and randomly assigned to the ED (n = 34: 51%) or a SD (n = 32; 48%); mean age was 47 (18-74) years. The primary healing rate was 64 out of 66 patients (96%). No statistical difference in healing rate was seen between the groups. However, patient satisfaction was significantly higher in the SD group (P < 0.0001).ConclusionsFistulectomy with primary sphincter reconstruction is a safe method with low complication rates. Postoperative stool behaviour has no significant influence on the healing rate but has a significant negative impact on patient satisfaction. Therefore, maintaining a standard diet seems to be preferable following reconstructive anal surgery.Trial registrationThe trial was registered with the German Clinical Trials Register (DRKS00020524).

The effects of gradual replacement of barley with oats on enteric methane emissions, rumen fermentation, milk production, and energy utilization in dairy cows

This study evaluated the effects of gradual replacement of barley with oats on enteric CH4 emissions, rumen fermentation, diet digestibility, milk production, and energy utilization in dairy cows fed a grass silage-based diet. Sixteen lactating Nordic Red dairy cows received a total mixed ration [58:42 forage:concentrate on dry matter (DM) basis]. Grass silage (Phleum pratense) was the sole forage with canola meal (10% of diet DM) as a protein supplement. The effects of gradual replacement of barley with oats on DM basis were evaluated using a replicated 4 × 4 Latin square design with 21 d periods. The grain supplements (30% of diet DM) consisted of 100% barley, 67% barley and 33% oats, 33% barley and 67% oats, and 100% oats. In addition to intake, milk production, and digestibility measurements, CH4 emissions were measured by the GreenFeed system (C-Lock Inc.). The energy metabolism was estimated from the gas exchange measurements recorded by the GreenFeed unit. The last 10 d of each period were used for recordings of gas exchanges, feed intake and milk production. Dry matter intake, body weight, milk yield, and energy-corrected milk yield were not affected by gradual replacement of barley with oats in the diet. Increased inclusion of oats linearly decreased CH4 emissions from 467 to 445 g/d, and CH4 intensity from 14.7 to 14.0 g/kg energy-corrected milk. In addition, the ratio of CH4 to CO2 decreased with increasing inclusion of oats in the diet. Digestibility of organic matter, neutral detergent fiber, and potentially digestible neutral detergent fiber decreased linearly with increasing inclusion of oats. Increased inclusion of oats linearly increased fecal energy from 121 to 133 MJ/d, whereas urinary energy and heat production were not affected by dietary treatment. This resulted in a linear decrease in metabolizable energy intake. However, increased levels of oat in the diet did not significantly affect energy balance or efficiency of metabolizable energy utilization for lactation. This study concludes that barley could be replaced with oats in the diet of dairy cows fed a grass silage-based diet to mitigate CH4 emissions without having any adverse effects on productivity or energy balance. However, the effect of replacing barley with oats on CH4 emissions is dependent on the differences between barley and oats in the concentrations of indigestible neutral detergent fiber and fat.

High versus low medium chain triglyceride content of formula for promoting short-term growth of preterm infants.

In-hospital growth of preterm infants remains a challenge in clinical practice. The high nutrient demands of preterm infants often lead to growth faltering.For preterm infants who cannot be fed maternal or donor breastmilk or may require supplementation, preterm formulas with fat in the form of medium chain triglycerides (MCTs)or long chain triglycerides (LCTs)may be chosen to support nutrient utilization and to improve growth.MCTs are easily accessible to the preterm infant with an immature digestive system, and LCTs are beneficial for central nervoussystem development and visual function. Both have been incorporated into preterm formulas in varying amounts, but their effects on the preterm infant's short-term growth remain unclear. This is an update of a review originally published in 2002, then in 2007. To determine the effects of formula containing high as opposed to low MCTs on early growth in preterm infants fed a diet consisting primarily of formula. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 8), in the Cochrane Library; Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, and Ovid MEDLINE(R); MEDLINE via PubMed for the previous year; and Cumulative Index to Nursing and Allied Health Literature (CINAHL), on 16 September 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs) and quasi-RCTs. We included all randomized and quasi-randomized trials comparing the effects of feeding high versus low MCT formula (for a minimum of five days) on the short-term growth of preterm (< 37 weeks' gestation) infants. We defined high MCT formula as 30% or more by weight, and low MCT formula as less than 30% by weight. The infants must be on full enteral diets, and the allocated formula must be the predominant source of nutrition. The review authors assessed each study's quality and extracted data on growth parameters as well as adverse effects from included studies. All data used in analysis were continuous; therefore, mean differences with 95% confidence intervals were reported. We used the GRADE approach to assess the certainty of evidence. We identified 10 eligible trials(253infants) and extracted relevant growth data from 7 of these trials (136 infants). These studies were found to provide evidence of very low to low certainty. Risk of bias was noted, as few studies described specific methods for random sequence generation, allocation concealment, orblinding.We found no evidence of differences in short-term growth parameters when high and low MCT formulas were compared. As compared to low MCT formula, preterm infants fed high MCT formula showed little to no difference in weight gain velocity (g/kg/d) during the intervention, with a typical mean difference (MD) of -0.21g/kg/d (95% confidence interval (CI) -1.24 to 0.83; 6 studies, 118 infants; low-certainty evidence). The analysis for weight gain (g/d) did not show evidence of differences, with an MD of 0.00 g/d(95% CI -5.93 to 5.93;1 study,18 infants;very low-certainty evidence),finding an average weight gain of 20±5.9 versus 20±6.9 g/d for high and low MCT groups, respectively.We found that length gain showedno difference between low and high MCT formulas, with a typical MD of 0.10cm/week (95% CI -0.09 to 0.29; 3 studies, 61 infants; very low-certainty evidence).Head circumference gain also showed little to no difference during the intervention period, with an MD of-0.04 cm/week (95% CI -0.17 to0.09; 3 studies, 61 infants; low-certainty evidence). Two studies reported skinfold thickness with different measurement definitions, and evidence was insufficient to determine if there was a difference(2studies, 32infants; very low-certainty evidence).There are conflicting data (5studies) as to formula tolerance, with 4 studies reporting narrative results ofno observed clinical difference and 1 study reporting higher incidence of signs ofgastrointestinal intolerancein high MCT formula groups.There is no evidence of effect on the incidence ofnecrotizingenterocolitis(NEC), based on small numbers in two trials.Review authors found no studies addressinglong-term growth parameters or neurodevelopmental outcomes. We found evidence of very low to lowcertainty suggesting no differences among short-term growth data for infants fedlow versushigh MCT formulas. Due to lack of evidence and uncertainty, neither formula type could be concluded to improve short-term growth outcomes or have feweradverse effects. Further studies are necessary because the results from includedstudies are imprecise due to small numbers and do not address important long-term outcomes. Additional research should aim to clarify effects on formula tolerance and on long-term growth and neurodevelopmental outcomes, and should include larger study populations to better evaluate effect on NEC incidence.

Indicadores de qualidade da terapia nutricional enteral são ferramentas úteis para o monitoramento em pacientes com câncer avançado em cuidados paliativos?

Introduction: Enteral nutritional therapy (ENT) in patients with advanced cancer in palliative care should be directed towards a better quality of life, being important its monitoring so that the patient has access to the best that the therapy can offer. The objective of this study was to apply the quality indicators of ENT in patients with advanced cancer in palliative care. Methods: Descriptive, observational study with a quantitative approach. Seven ENT quality indicators proposed by the International Life Sciences Institute in Brazil were applied and the reasons for the suspension or interruption of the enteral diet during hospitalization were quantified. Results: 51 patients admitted from May to November 2019 participated in the study. The frequencies of inadvertent exit of enteral nutrition tube (0.02%), the days of adequate administration of the prescribed volume versus infused volume (92.6%) and diarrhea (2%) are within the goal used. The administration of protein (25.5%) and energy (57.4%), the frequency of episodes of abdominal distension (33.3%) and constipation (86.3%) were inadequate. The diet was interrupted or suspended mainly due to the occurrence of vomiting, end-of-life care or tube obstruction. Conclusion: The use of quality indicators of nutritional therapy proved to be viable in this group of patients. Some inadequacies found in this population may be associated with the change in the objective of nutritional therapy in patients with shorter life expectancy. Adaptations based on the prognosis may be necessary, in addition to the application of new indicators, or adjustments to the proposed goals.

Nutrição enteral precoce e desfechos clínicos em pacientes de terapia intensiva

Introduction: Early nutritional support is a therapeutic strategy in critically ill patients, however, it has been shown to be controversial in relation to clinical outcomes. The aim of the study was to investigate the effects of early enteral nutritional therapy (ENT) and the initial caloric-protein supply on the clinical outcomes of patients in Intensive Care Units (ICU) of a hospital in Southwest Bahia. Methods: Prospective cohort study approved by the ethics committee. Information was collected on nutritional screening, anthropometric assessment, estimated nutritional needs and nutritional goals. The time of introduction of NET was classified as early, when started in the first 48 hours of admission and late. The volume and characteristics of the enteral diet were monitored daily, as well as the length of stay in the ICU and mechanical ventilation and mortality. Patients were followed up until discharge from the ICU or death. To test the association between the outcomes of mechanical ventilation time and ICU stay and nutritional variables, linear regression was used, while, for mortality, logistic regression. Results: 88 patients were included, of which 96.6% had nutritional risk at admission, determined by the severity of the condition. Early NET was received by 67 patients, with a mean of 39 ± 11.69 hours to onset and significant variation in relation to late NET (77.76 ± 32.11 hours), with no association with outcomes. The caloric and protein averages received in the first three days of NET were significantly higher in the early NET group (p = 0.000), which were associated with longer ICU stays and mechanical ventilation, even with a high frequency of protein inadequacy. No late ENT patient presented protein adequacy until the third day. Conclusion: Early NET was not associated with the clinical outcomes of critically ill patients, however, the greater energy supply increased the ICU stay and mechanical ventilation times.

Desperdício de dietas enterais em hospital terciário

Introduction: Nutritional therapy is essential in the care of patients at nutritional risk or malnourished, since it is associated with an adequate offer of benefits for recovery of nutritional status and reduction of complications associated with malnutrition. Differences between prescribed and infused volume, in addition to bringing changes in the nutritional status of patients, are also associated with the waste of resources such as bottles and enteral diets and increased costs. This study aims to analyze aspects related to the despair of enteral diets in a tertiary hospital. Methods: Retrospective study carried out through analysis quantitative analysis of secondary data collected as a routine in the enteral nutrition sector, from August 2018 to August 2019. Results: 647 assistance events were registered in the adult assistance units and children. As diets with the highest percentage of dispensing for adults were open system polymeric and, for children, as specialized, and also as diets with a higher percentage of despair. There was a significant relationship between the volume dispensed and the amount wasted, showing the greater the volume of diets dispensed, the greater the number of despair events. The direct cost of waste is less than the real cost since the database has changed, starting to account for costs with modules and flasks that weren’t initially accounted for. The biggest reason for despair was zero diet for both adults and children. A significant association was evidenced between lack of communication and despair. Conclusions: The greatest the volume of diets dispensed the greater the number of wasteful events, the lack of communication was identified as a determinant in the occurrence of the same. It is necessary to continue studies related to waste in order to detail all variables and direct and indirect costs related to the fact.

Cuidados paliativos e demência avançada: trajetória de idosos hospitalizados nas últimas 48h de vida

This study aimed to analyze the last 48 hours of life of hospitalized elderly with advanced dementia and the profile of care over the 5 years analyzed. This is a retrospective cross-sectional study, through the analysis of electronic medical records of patients participating in the study, who died between January 1, 2013 and December 31, 2017. 328 medical records were analyzed in the defined period and 97 met the inclusion criteria. Ninety-three patients (95.9%) had records of advance directives of their wills, 73.2% were female, with a mean age of 88.7 years, 52.6% of deaths occurred in an apartment or infirmary, in the latter 48h of life, 64.9% were on an enteral diet, 28.9% were breathing by mechanical ventilation, 51% were using antibiotics, and 86.6% were prescribed fixed analgesia; however, 19% had a record of uncontrolled pain. Over the 5 years of observation, there were changes in the following aspects: reduction of deaths in the intensive care unit (60% vs. 36.4%), decrease in the use of tube feeding (87% vs. 32%), in the use of mechanical ventilation (53% vs. 18%); the use of central venous catheter (47% vs. 27%); the use of permanent urinary catheter (27% vs. 5%), and the presence of pressure injuries (87% vs. 45%). It is concluded that in the 5 years of analysis a palliative trend in care was characterized by the reduction of procedures considered invasive, in the last 48 hours of life, in patients with advanced dementia.

Preterm infant nutrition and growth with a human milk diet

Human milk is the preferred enteral diet for preterm infants. It provides macronutrients, micronutrients, and bioactive factors that support physical growth and neurodevelopment. Challenges of the human milk diet include the variability in its composition and a need for fortification to mirror placental nutrient delivery and prevent extrauterine growth restriction. Various strategies exist to attain target nutrient provision and optimize growth, including leveraging new technology for point-of-care human milk analysis. When maternal milk is unavailable or in short supply, pasteurized donor human milk is the preferred alternative. Infants fed donor milk may have slower weight gain than those fed exclusively maternal milk or formula, whereas infants fed fortified maternal milk have similar weight gain to preterm formula-fed infants. Future directions include more rigorous characterization of the variation in human milk, further investigation of the clinical benefits of non-nutrient bioactive factors in milk, and novel approaches to optimize fortification.

Clinical effect of enteral nutrition with eicosapentaenoic, docosahexaenoic, and gamma-linolenic acids for preventing bedsores after neurosurgery

Rationale: Enteral diets enriched with EPA・DHA・GLA contributed to preventing bedsores in patients after neurosurgery. The beneficial effect of the EPA・DHA・GLA diets was associated with a lower occurrence of new bedsores in the clinical nutrition management of neurosurgical outcomes.

Cholestasis incidence in newborns with gastroschisis using different lipid emulsions in parenteral nutrition

Rationale: Gastroschisis are congenital defects of the abdominal wall and required prolonged parenteral nutrition. Difficulty in initiating enteral diets,infections,use of PN and lipid emulsion contribute to the incidence of cholestasis.

An Immune-modulating Diet Maintains Food Intake during Cancer Chemotherapy

An immune-modulating diet (IMD), an enteral diet enriched with immunonutrition and whey-hydrolyzed peptides, has been shown to bring an improvement of prognosis by suppressing inflammation after surgery or under stress. In this study, we have experimentally and clinically examined the effect of the IMD in cancer chemotherapy. In experiments using colorectal cancer cell-transplanted mice, the mice fed with the IMD in combination with anti-cancer agent significantly tended to maintain plasma body weight excluding tumor, and to reduce plasma interleukin-6 (IL-6) levels compared with the control group. Furthermore, normal mice fed with the IMD elevated the level of plasma ghrelin, in particular acyl ghrelin. An clinical trial for a patient with malignant lymphoma revealed that the acyl/desacyl ghrelin ratio and total calorie intake was increased when the patient was supplemented with the IMD in conjunction with chemotherapy. These results suggested that the supplementation of the IMD during cancer chemotherapy might enable to maintain the food intake of the patients through elevating plasma acyl ghrelin levels.

Fatores de interrupção de nutrição enteral em unidades de terapia intensiva adulto: revisão integrativa

Objetivo: identificar na literatura os principais fatores de interrupção de nutrição enteral em unidades de terapia intensiva adulto. Método: revisão integrativa da literatura, viabilizada através de coleta de dados nas bases de dados da LILACS, Medline e Scopus, com recorte cronológico de 2010 a 2020. Foram utilizados os descritores de busca: “Nutrição Enteral” ou “Enteral Nutrition”, “Cuidados Críticos” ou “Critical Care”, “Desnutrição” ou “Malnutrition”. Resultados: Dos 10 artigos selecionados para leitura e análise, foi possível identificar que os principais motivos de interrupção de dieta enteral foram: 08 (80%) pausa para exames, procedimentos e cirurgias, 06 (60%) intolerância gastrointestinal, 03 (30%) extração ou dificuldades com acesso enteral, 02 (20%) diarreia e 02 (20%) por instabilidade clínica. Conclusão: A pesquisa permitiu identificar na literatura os principais fatores causadores de interrupção de dieta enteral em unidades de terapia intensiva, apontando alguma similaridade entre os diferentes países e cenários. Emergindo assim, a recomendação de novas pesquisas sobre o tema, que proponham avaliar o conhecimento de profissionais de saúde acerca da temática da terapia nutricional, a fim de nortear a elaboração de planos educacionais e de treinamento.

Isolated Intestine Transplantation for Autoimmune Enteropathy: A Case Report

Autoimmune enteropathy is a rare disease characterized by chronic watery diarrhea, weight loss, and immune-mediated injury of the enterocolic mucosa. The clinicopathologic findings of this disease are variable, and timely diagnosis is challenging. It is usually managed medically. If medical management fails, surgical intervention is considered. This is a case report of a patient with autoimmune enteropathy mimicking collagenous enterocolitis. A 55-year-old man developed intestinal failure that manifested as profuse watery diarrhea, electrolyte disturbances, and weight loss. Initially, he was diagnosed with collagenous enterocolitis based on pathologic findings. Medical interventions were started, but the patient failed to show improvement. At 13 months after the onset of the disease, he was listed for isolated intestine transplantation (IITX) for intestinal failure. A healthy donor graft became available. IITX with chimney colostomy was performed. Based on the pathologic findings of the excised native small intestine, the patient was diagnosed with severe autoimmune enteropathy. The postoperative course was uneventful. By the third postoperative week, a full diet was tolerated and parenteral nutrition (PN) was weaned to end. He was discharged on postoperative day 34. Since discharge, he has been off PN, remaining on an enteral diet. This case is the first reported IITX performed on a patient with severe autoimmune enteropathy that was both curative and lifesaving. The present case confirms that IITX promptly restores gastrointestinal absorption in medically refractory autoimmune enteropathy. This observation provides clinicians with an effective treatment option in this challenging group of patients.

Home Enteral Nutrition in Adults-Nationwide Multicenter Survey.

Home enteral nutrition (HEN) is an important part of the health care system, with a growing population of patients around the world. The aim of our study was to analyze one of the largest cohorts of HEN patients to provide the most recent data available in European literature. A multicenter, nation-wide survey in the period of 1 January 2018–1 January 2019 was performed in Poland. Data concerning adult patients on HEN in 2018 during 1 year of observation time were analyzed: demographic characteristics, primary disease, technique of enteral feeding, diet formulation and amount of energy provided. A total of 4586 HEN patients (F: 46.7%, M: 53.3%) were included in the study. The primary diseases were: 54.5% neurological (17.4%—neurovascular, 13.7%—neurodegenerative), 33.9% cancer (20.2%—head and neck, 11.7%—gastrointestinal cancer), 2.5%—gastroenterology, 1.5%—inherited diseases. Of new registrations in 2018—cancer patients 46.3%, neurological patients 45.1%. The median age overall was: 64 yr., BMI-20.2 kg/m2, NRS 2002 score—4.28. A total of 65% of patients were treated with PEG, 11.6% with surgical gastrostomy, 14.3% with naso-gastric tube and 7% with jejunostomy. Boluses were the most common method of feeding (74.4%). Gravity flow was used in 17.6% and peristaltic pump was used in 8% patients. The median energy provision was 1278 kcal/day and 24 kcal/kg/day. The most commonly used diets were: isocaloric (28.1%), protein-enriched isocaloric (20%) and protein-enriched hypercaloric (12%). The median overall duration of HEN was 354 days, 615 days for neurological and 209 days for cancer patients. A number of new registrations of cancer patients was significant and long duration of HEN in this group is encouraging. A developing spectrum of enteral formulas available enables more specified nutritional interventions.